Provider Demographics
NPI:1376862391
Name:ONOSODE, TORITSENERE B (DPM)
Entity Type:Individual
Prefix:DR
First Name:TORITSENERE
Middle Name:B
Last Name:ONOSODE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:NERE
Other - Middle Name:BLESSING
Other - Last Name:ONOSODE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3245 MAIN ST STE 235-308
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4411
Mailing Address - Country:US
Mailing Address - Phone:972-864-7353
Mailing Address - Fax:972-864-7354
Practice Address - Street 1:3140 LEGACY DR STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-864-7353
Practice Address - Fax:972-864-7354
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2065213ES0103X
KY00356213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100209480Medicaid
KYK050280Medicare PIN
KYK050281Medicare PIN
KYP01085240Medicare PIN